- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,952.30 / $4,002.46 / $8,768.00
| Facility | | $1,952.30 | $4,002.46 | $8,768.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,105.25 / $16,184.00 / $28,850.83
| Facility | | $8,105.25 | $16,184.00 | $28,850.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,372.84 / $2,372.84 / $3,312.01
| Facility | | $2,372.84 | $2,372.84 | $3,312.01 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $234.84 / $234.84 / $234.84
| Facility | AS | $234.84 | $234.84 | $234.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $3,325.00 / $8,198.00
| Facility | | $1,403.00 | $3,325.00 | $8,198.00 |